Governance reforms for Pakistan’s National Institute of Health: Addressing challenges in disease surveillance and emergency management: A qualitative study

The Centers for Disease Control in National Institutes of Health (CDC-NIH) in Pakistan is mandated to implement the Integrated Disease Surveillance and Response System (IDSRS) as well as a Public Health Emergency Management System (PHEMS) across the country for global health security and IHR-2005 compliance. This study aims to identify challenges in implementing IDSRS and PHEMS, explore the role of CDC-NIH as a leading public health agency, and propose solutions to improve coordination and governance. A qualitative approach was employed and data was collected through interviews. A rapid thematic content analysis approach was used for data analysis. The findings reveal that Pakistan's public health system faces substantial challenges, particularly in implementing the IDSRS and managing public health emergencies. These constraints are deeply rooted in structural factors including: decentralization, which disperses authority across various levels; fragmented governance, leading to coordination problems; resource constraints that limit effective response; and legislative gaps that hinder policy implementation. These governance and legislative factors significantly impede Pakistan's ability to respond efficiently to crises in the health system. Addressing these issues requires formalizing coordination mechanisms to ensure seamless collaboration and communication among stakeholders, clarifying governance arrangements to delineate roles and responsibilities, and establishing strong legal frameworks that provide a secure and enforceable foundation for actions. The strategic evolution of the CDC-NIH into a central coordinating authority could lead to a fundamental shift in public health governance, positioning it as a vital investment in national security, human development, and Pakistan's health system resilience.